Senate votes to expand women's health coverage with Medicaid

Thursday, April 5, 2007

JEFFERSON CITY, Mo. -- State senators voted Wednesday to expand women's health care and family planning services to tens of thousands of Missourians as part of a plan to revamp the state's Medicaid program.

The proposal, if enacted, could mark the most significant expansion of government-funded health care since the Republican-led legislature and Gov. Matt Blunt reduced or eliminated Medicaid services for hundreds of thousands of people two years ago.

Under the amendment, as many as 90,000 women age 18 and older could receive government-paid pelvic exams, cancer screenings, family planning counseling on birth control and testing and treatment of sexually transmitted diseases. To qualify, a single woman could earn up to $18,889 a year.

The women's health amendment was added by voice vote to a Blunt-backed bill that would rename the Medicaid program "MO HealthNet," place a greater emphasis on preventive health care and reward patients and physicians with extra benefits or money for good efforts.

Final vote needed

Senators gave first-round approval to the broader bill Wednesday night by a bipartisan voice vote. A final vote is needed to send the bill to the House.

"What we're trying to do in Missouri HealthNet is entirely replace the old Medicaid system and move from a focus on responding to sickness to a focus on health and wellness," Blunt said.

On Tuesday, Republicans rejected a Democratic-led attempt to restore Medicaid coverage to 37,000 low-income parents whose eligibility was cut in 2005. Wednesday, Republicans defeated, 18-16, a broader Democratic amendment that would have restored most of the 2005 cuts. The only Republicans voting with minority party Democrats were Sens. Jason Crowell of Cape Girardeau, Rob Mayer of Dexter and Kevin Engler of Farmington.

Blunt opposed the restoration of the eligibility cuts.

"We need to have fiscal discipline, and we need to be responsible with tax dollars," Blunt said at a news conference Wednesday before the Senate votes.

But Senate Majority Leader Charlie Shields, who is sponsoring the bill, embraced the women's health-care amendment by Democratic Sen. Harry Kennedy, of St. Louis.

"This is probably money well spent," Shields said.

The Department of Social Services projected the women's health program would cost $5 million annually in state general revenues, though the actual cost could be slightly lower because Shields added language excluding women with assets of more than $250,000.

The federal government would match every $1 the state spends with $1.50-$9 of its own, depending on the service. Family planning services, for example, attract the highest federal match.

"This is an important population to serve," said Shields, R-St. Joseph. "The dollars that are going to be spent on family planning ultimately are going to save the system money on sexually transmitted diseases and such."

Missouri's Medicaid program already covers pregnant women earning up to 185 percent of the federal poverty level. After they give birth or miscarry, those women already receive family planning and women's health services for an additional year.

The amendment approved by the Senate would grant those same services to women at those same income levels regardless of whether they ever are pregnant.

No senators spoke against the measure, though few were in the chamber when it was debated and approved.

Senators also added anti-fraud provisions to the legislation, but opted for less stringent measures than many of them preferred.

They added the elements of a House-passed bill that would allow the attorney general's office to use whistleblower information to pursue fraud lawsuits, but would not allow individuals to bring the lawsuits themselves. Whistleblowers who brought the information to the attorney general's attention could receive 10 percent of the legal award.

That's substantially less than the 35 percent whistleblowers could have received under an anti-fraud bill the Senate passed last year. But that bill died in the House because of concerns by physicians that private attorneys would pursue lawsuits against them seeking to portray mere mistakes as fraud.

Some senators continued to push for the more-stringent version this year. But Sen. Chris Koster, R-Harrisonville, who sponsored last year's bill, said the House version was probably as much as they could expect to get.

"It's not the full Monty, but it's not a bad show," Koster said.

Medicaid bill is SB577.

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